Practice Management
A 4-year-old male presents to urgent care with a swollen, painful right elbow. The mother reports that the child had a witnessed fall from the monkey bars 1 hour prior to arrival. He fell onto his outstretched right hand, was in immediate pain that has not subsided, and has refused to let anyone touch his arm. On initial examination, vital signs are stable, and patient is afebrile. Swelling is noted over the right elbow, and …
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A 53-year-old woman visits urgent care for dark patchy spots on her neck and face that have been spreading over the past 3 months. The lesions are not painful or itchy, she denies exposure to allergens or irritants, and has no systemic symptoms. The patient states that sun exposure darkens the spots further and she has not tried any treatments to date. On examination she appears well with normal signs; hyperpigmented gray macular patches are …
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A 60-year-old male with a past medical history of prior myocardial infarction (MI) is presenting with left-sided chest pain for 1 day. He reports nonadherence to his clopidogrel for 2 weeks after running out of his medications. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 7‑year‑old male presents to the urgent‑care clinic with left‑knee pain that began after gym class and has gradually worsened over the past several weeks. The mother reports no significant trauma and notes that the pain improves with rest. Physical examination reveals a slightly overweight child with a visible bowing deformity just distal to the knee. The patient demonstrates a full range of motion and normal knee strength, and no bony tenderness, effusion, or laxity …
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A 52-year-old man presents to urgent care with a 2-day history of left calf pain, described as dull, non-radiating, and worsened by walking. He recently flew from Los Angeles to New York. His history includes hypertension managed with lisinopril. He denies fever, chest pain, shortness of breath, recent surgery, or prior clots. He appears well and is hemodynamically stable. Exam reveals mild swelling and tenderness in the left calf and popliteal region without erythema or …
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A 45‑year‑old male presents to urgent care with headache, malaise, and an arm lesion that appeared three days ago. He reports no recent travel but notes several mice in his New York City apartment. On examination he is febrile (39.4 °C / 101 °F) and dermatologic exam reveals an eschar lesion with surrounding erythema and adjacent erythematous papules on the arm. Numerous scattered papulovesicles are also present on the trunk and forearms. Laboratory studies show mild leukopenia …
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A 55-year-old male presents to urgent care with progressive dyspnea for 2 weeks associated with lower extremity edema. The patient is afebrile, slightly tachypneic, with bilateral lower extremity edema on exam. An ECG is ordered. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 21-year-old male with no significant past medical history presents to urgent care with a 3-week history of progressive cough, night sweats, dyspnea, and chest discomfort. He denies sore throat, rhinorrhea, sinus congestion, hemoptysis, weight loss, wheezing, tobacco use, or illicit drug use. On examination, vital signs are within normal limits. The patient appears well and not in acute distress. Lung auscultation was clear bilaterally, and the remainder of the initial physical exam is unremarkable. …
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A 60-year-old female presents to urgent care with palpitations that started abruptly 1 hour prior to arrival. She denies recent illness or cardiac history. An ECG is ordered. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 16-year-old male presents to urgent care accompanied by his father due to acute onset of fever, abdominal pain, fatigue, altered mental status, and a lower-extremity rash. Symptoms began earlier the same day. The patient denies recent upper respiratory symptoms, medication use, travel, or trauma. On physical examination, he appears acutely ill and febrile to 103.1°F (39.5°C). Neurologic assessment reveals altered mental status. Dermatologic exam shows retiform, violaceous purpuric plaques with maroon borders on both …
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